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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator vc� Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N 0 N <br /> QAA � <br /> OWNER rA tt r ktl TELEPHONE O 1 j— q3 42 6/'7 g n <br /> o <br /> MAILINGADDRESS v <br /> "1 I l� 1� e s�-- 113+1; s�-rt '. I��c�vvvl iac�ny'V1 K Ss�t3 f <br /> J� 0 <br /> o <br /> PROPERTY ADDRESS <br /> _ 1 <br /> LEGAL DESCRIPTION(see tax receipt) �yy� a�j© r tnt� .t(•(UAAr I H.(. m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION AT O 0 <br /> 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING CAMPING UNIT 1-1SUBDIVISION ❑ <br /> n <br /> STRUCTURE/ADDITONUSE: -P l C—1 o is-e1 kir, 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Cn <br /> Vh v s-zt <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> XI m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om <br /> n a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF c <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. qj <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. S o t <br /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VER TION MAY BE DONE WHEN o o <br /> NEEDED. <br /> j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. J � V3 ;E <br /> CONDITIONS OF PERMIT: 1 <br /> rADD <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAY OF PERI FF I <br /> ISSUANCE. pp I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG'3 �d�' <br /> 3 NO GRADINGED. OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ZQN'NCG UNTY <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 'O ry <br /> 7. Z ym0 <br /> a -n� <br /> I declare that this application Including any accompanying schedule) has been examined by me and to the best of my — N A <br /> knowledge and belief it is true, orrect and complete. I acknowledge that I am responsible for the detail and accuracy of m vi C <br /> all information contained in this pplication(including any accompanying schedule)and I further declare that I recognize d1 m o v <br /> that this information I am provid g will be reli upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue apermit. 1 further accept all lability hic may bear ult of the County of Burnett relying on this information I am �: d <br /> providing in this applic do I a ree t pe it county Icials charged with administering county ordinances or other m <br /> authorized person a ccs o t a e desc ' premises at any reasonable time for the purpose of inspection. T ° o <br /> �S 03 <br /> SIGN HERE d' n <br /> ure of owner or building c ctor) (date) <br /> ZONING ADMINI TRATOR ! . <br /> v,Fn <br /> ER fAMfA -+ N <br /> r� N (TNNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />